[Risk factors for the development of liver cancer in patients with hepatitis B-related liver cirrhosis treated with long-term nucleos(t)ide analogues].

Objective: To retrospectively analyze the risk factors for the development of liver cancer in patients with hepatitis B-related liver cirrhosis (LC) treated and fully managed with long-term nucleos(t)ide analogues (NAs). Methods: The study subjects were derived from the follow-up cohort of chronic hepatitis B and liver cirrhosis who received antiviral therapy in the Department of Infectious Diseases of the First Affiliated Hospital of Guangxi Medical University from February 2004 to September 2019. LC patients who met the inclusion criteria were enrolled. The life-table method was used to calculate the incidence of liver cancer. Multivariable Cox regression model was used to analyze the risk factors that may affect the development of liver cancer in patients with LC. A subgroup analysis was conducted in liver cirrhotic patients who developed liver cancer to evaluate the effectiveness of antiviral treatment compliance. The (2) test was used for rate comparison. Results: The median follow-up time of 198 LC cases treated with NAs was 6.0 years (1.0-15.3 years). By the end of the visit: (1) 16.2% (32/198) of LC patients had developed liver cancer, and the cumulative incidence of liver cancer in 1, 3, 5, 7, and 9 years were 0, 8.9%, 14.3%, 18.6%, and 23.4%, respectively, with an average annual incidence of 3.1%. Among the 32 cases with liver cancer, 68.7% had developed small liver cancer (22/32). (2) Univariate Cox model analysis showed that the development of liver cancer was related to four factors, i.e., the presence or absence of LC nodules, whether the baseline was first-line medication, the family history of liver cancer, and patient compliance. The results of multivariate Cox model analysis showed that poor patient compliance and baseline non-first-line medication were risk factors for liver cancer. (3) The results of log-rank test subgroup analysis showed that the 5-year cumulative incidence of liver cancer in patients with hardened nodules was significantly higher than that of patients without hardened nodules (21.7% vs. 11.5%, P = 0.029). The 5-year cumulative incidence of liver cancer in patients with non-first-line drugs was significantly higher than that of patients with first-line drugs (22.0% vs.8.2%, P = 0.003). The 5-year cumulative incidence of liver cancer in patients with poor compliance was significantly higher than that of patients with good compliance (21.3% vs. 12.7%, P = 0.014). The 5-year cumulative incidence of liver cancer in patients with a family history of liver cancer was significantly higher than that of patients without a family history of liver cancer (22.3% vs. 8.1%, P = 0.006). (4) Compared with patients with poor compliance, patients with good compliance had higher HBV DNA negative serconversion rate (98.7% vs. 87.8%, P = 0.005), and a lower virological breakthrough rate (12.1% vs. 29.3%, P = 0.007). Conclusion: The long-term NAs antiviral therapy can reduce the risk of liver cancer, but it cannot completely prevent the development of liver cancer, especially in patients with a family history of liver cancer and baseline hardened nodules (high risk of liver cancer). Furthermore, the complete management can improve patient compliance, ensure the efficacy of antiviral therapy, and reduce the risk of liver cancer development, so to achieve secondary prevention of liver cancer, i.e., early detection, diagnosis and treatment.

[Liver histological status and clinic outcome in HBeAg-negative chronic hepatitis B with low viral load].

Objective: To retrospectively analyze the serological, virological, biochemical, liver histological status and clinical outcomes in HBeAg-negative chronic hepatitis B (CHB) patients with low HBV viral load, and to explore the necessity of antiviral therapy for these patients. Methods: A total of 99 HBeAg-negative CHB patients with HBV DNA level < 4 lg copies/ml who performed liver biopsy at the baseline were enrolled from the follow-up cohort. Among them, 23 cases received the second liver biopsy during follow-up. The relationships among the degree of inflammation and fibrosis of liver tissues, the status of HBsAg and HBcAg, age, gender, family history, HBV DNA load, serological markers and other indicators were analyzed. The pathological differences between two liver biopsy examinations were compared. The effect of nucleos(t)ide analogues (NAs) treatment on patient's clinical outcomes were analyzed. For multivariate analysis, a binary logistic regression model was performed. Log-rank test was used to compare the cumulative incidence of hepatocellular carcinoma (HCC) in NAs-treated and non-NA streated patients. Results: Baseline liver histology status showed that 58.6% (58/99) patients had obvious liver tissue damage in their baseline liver tissue pathology (G≥2 and /or S≥2). Univariate logistic regression analysis showed that a liver cirrhosis (LC) family history, a HBsAg-positive family history, baseline alanine aminotransferase and aspartate aminotransferase levels were positively correlated factors for liver tissue damage. Multivariate logistic regression analysis showed that a LC family history was the main risk factor for liver tissue damage. Twenty-three cases had received a second liver biopsy after an interval of 4.5 years. In 10 untreated cases, the second liver biopsy results showed the rate of obvious liver tissue damage (G≥2 and/ or S≥2) increased from 50.0% to 90.0%. In the other 13 cases who received NAs treatment, the second liver biopsy showed improvement in liver histology, and the rate of obvious liver tissue damage decreased from 61.5% to 46.2%. The 5-year HCC cumulative incidence in non-NAs-treated patients was significantly higher than that of in NAs-treated patients (17.7% vs. 3.8%, P = 0.046). Conclusion: For most HBeAg-negative CHB patients with low viral load, liver tissue pathology result suggests that it meets the indications for antiviral therapy, especially in patients with a LC familial history. Without antiviral therapy, liver tissue damage for these patients will progressively worse with the high incidence of HCC. Therefore, it is suggested that antiviral therapy should be started as soon as possible for the HBeAg-negative CHB patients with low viral load regardless of the alanine aminotransferase level, especially in patients over 30 years-old with a LC or HCC family history.

Diacetylamethystoidin A protects isolated working rat heart against myocardial reperfusion injury.

AIM: To observe the effect of diacetylamethystoidin A (6 alpha, 13 beta-diacetyl-11, 15-dioxo-19-hydroxyl-kaurene, DAA-A) on myocardial ischemia reperfusion injury. METHODS: Working heart mode was induced in isolated rat heart subjected to a 40-min ceasing perfusion followed by a 25-min reperfusion. RESULTS: DAA-A 0.13, 0.25, 0.50 mmol.L-1 reduced the incidence of ventricular fibrillation (1, 1, 0 vs 4 in Vehicle and 5 in Control, respectively), increased the coronary flow (mL.min-1, 1.8 +/- 0.9, 1.9 +/- 0.8, 1.7 +/- 0.6 vs 1.0 +/- 0.3 in Vehicle and 0.9 +/- 0.5 in Control as reperfusion time 5 min, respectively), improved the contractile function of heart, decreased the release of lactic dehydrogenase (LDH) and malondialdehyde (MDA). DAA-A 0.25 mmol.L-1 reduced the injury of myocardial cell ultrastructure. CONCLUSION: DAA-A has cardioprotective effect through diminishing cellular lipid peroxidation induced by oxygen free radicals.

Effects of cyproheptadine on TXB2 and 6-keto-PGF1 alpha plasma levels in rabbits with hemorrhagic shock.

Profound hemorrhagic shock was produced in 26 rabbits by exsanguination via carotid artery until blood pressure (BP) = 5.3 kPa (40 mmHg) for a period of 90 min. Rabbits were equally divided into a cyproheptadine (Cyp) treated group and a control group. The blood samples before and 90 min after shock and 30 min after liquid and blood infusion and administering Cyp (10 mg.kg-1) were collected from the carotid artery. With radioimmunoassay, we measured the thromboxane B2(TXB2) and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) contents in plasma. The results indicated that the TXB2 and 6-keto-PGF1 alpha levels during shock (1024 +/- 924, 30 +/- 32) and after liquid and blood infusion (990 +/- 943, 60 +/- 54) were higher than those (221 +/- 134, 6 +/- 4) in normal rabbits (P < 0.01, P < 0.05). Cyp reduced obviously the TXA2 plasma level in rabbit with shock (304 +/- 299 vs 990 +/- 943, P < 0.05). We conclude that the decrease of TXB2 content is one of the possible mechanisms of cyproheptadine anti-shock effect.

Effects of cyproheptadine on plasma superoxide dismutase activity and malondialdehyde content in rabbits with hemorrhagic shock.

Profound hemorrhagic shock was produced in thirty rabbits by exsanguination via the carotid artery until blood pressure (BP) reached 5.3 kPa (40 mmHg) and was sustained for a period of 90 minutes. The rabbits were equally divided into cyproheptadine (Cyp) treated group and control group. Blood samples 30 minutes after liquid and blood infusion and administration of Cyp (10 mg/kg) were collected from the carotid artery, and the plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) content measured. The results showed that Cyp remarkably enhanced the plasma SOD activity (2462 +/- 338 vs 1955 +/- 596, P < 0.01) and reduced MDA content (2.68 +/- 0.24 vs 3.20 +/- 0.49, P < 0.01). We believe that the increase of O2 production plays an important role in the development of shock, the single blood and liquid infusion can not significantly improve the shock conditions. Scavenging oxygen free radicals and alleviating cellular damage and multiple organ failure are the possible mechanisms of cyproheptadine anti-shock effect.

Anti-shock effect of cyproheptadine in rabbit.

Twenty four New Zealand rabbits were equally divided into a cyproheptadine (Cyp) treated group and a control group. Profound hemorrhagic shock was produced by exsanguination via carotid artery until mean arterial pressure (MAP) = 5.3 kPa (40 mm Hg) for a period of 90 min. After given Cyp 10 mg.kg-1, the MAP and central venous pressure (CVP) of the treated group rose obviously (P less than 0.01) and the mesenteric microcirculation improved markedly. After 1 h, all indices returned nearly to the preshock state. The survival rate 2 h after Cyp increased to 12 (P less than 0.01) in comparison with the control group (7). The results showed that Cyp, which dilates the vasculature and improves the microcirculation through blocking serotonin S2 and histamine H1 receptors, has a beneficial anti-shock effect.